Payers are becoming 'activist'

Payers are becoming 'activist'

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​In response to financial pressures, governments are using payment models to incentivize change in practice, behaviours and outcomes. There is a shift from volume-based payments to incentives and payments based on value (outcomes and quality).

This is creating a new challenge for health providers and forcing them to replace traditional care delivery with innovative partnerships and new perspectives. Overall, providers do not feel well-equipped to respond to these changes, including bundled payments, increased risk sharing and value-based purchasing. However, providers do feel that reduced costs and improved outcomes can be achieved through truly integrated care.

The State of New York is taking the lead in the US through the transformation of its Medicaid system. As part of a wider system transformation, New York State is reforming payment models to pay for value instead of volume. Similarly, in Ontario, Canada, the Ministry of Health and Long-Term Care has commissioned six integrated and bundled care pilots where payment models were tested – some based on payment for outcomes.